Psychoanalysis was the most dominant form of Psychotherapy for much of the 20th Century. Thus, the Psychoanalysis Approach comprised of visiting a therapist several times a week, often for years.
However, various approaches to Psychotherapy began to appear in the 1970s. Many of these approaches were of shorter duration lasting only weeks or months.
Besides this, only a handful of approaches are highly effective for treating mental disorders like Depression, Anxiety, Phobias, and Stress.
Origin of CBT
Cognitive Behavioral Therapy (CBT) is one of the many available therapies that is the best type of therapy for such mental challenges. More than 375 clinical trial studies and current international treatment guidelines support this conclusion since 1977.
All such studies and guidelines are based on the combined knowledge of experts in the field of Cognitive-Based Therapies. For instance, the NIMH in the US and the NICE in the UK recommend CBT Therapy as the preferred psychological treatment.
Besides this, CBT Therapy has proved to be an effective psychological treatment for people belonging to different age groups, income, and education levels.
So, let’s understand what is Cognitive Behavioral Therapy in psychology and how CBT works?
What is Cognitive Behavioral Therapy?
As per the American Psychiatric Association, the Cognitive Behavioral Therapy (CBT) definition is as follows:
CBT represents a unique category of psychological interventions. Such interventions are based on scientific models of human behavior, cognition, and emotion. Thus, CBT Therapy includes a wide range of treatment strategies. These strategies take the current knowledge about the causes and maintenance of the different mental disorders into account.
In other words, Cognitive Behavioral Therapy in Psychology is an intensive, short-term, and problem-oriented approach. In such an approach, both the therapist and the patient work together to identify and understand the problems. They study the problems in the context of the relationship between thoughts, feelings, and behavior of the patient.
What Does Cognitive Therapy Focus On?
The focus of CBT Therapy is on the here-and-now. In other words, cognitive therapy focuses on the problems that a person faces in his or her day-to-day life. It is a form of cognitive psychotherapy intending to solve a person’s current problems. Furthermore, this approach modifies the person’s dysfunctional thinking and behavior.
Thus, CBT helps people to understand the way they interpret their problems. In addition to this, it helps them to analyze what’s happening around them. It also helps them know the impact of their perception on their own emotions.
It’s important for you to know that the childhood experiences of a person are not the primary focus of CBT. However, a therapist may review his patient’s childhood experiences and events. The knowledge of these events would help the therapist understand the emotional experiences that occurred early in his patient’s life.
How Does CBT Work?
The following are the steps in CBT that will explain how does CBT work step by step.
I. Identifying Automatic Thoughts
Automatic Thoughts are the thoughts that arise spontaneously. Such thoughts coexist with a set of more prominent thoughts. Furthermore, the Automatic Thoughts are not based on evaluation or reflection.
Besides this, automatic thoughts occur for a very brief period of time. And the patients experiencing automatic thoughts are more often aware of the associated emotion than the thoughts themselves.
Furthermore, the automatic thoughts:
- May be in verbal form, visual form, or both
- You can evaluate according to utility and validity
- Are common to all of us and not peculiar to people with psychological distress
- Unknown to us most of the times
Also Know: How CBT Works with Patients
However, people experiencing psychological distress are unable to engage in the critical examination of automatic thoughts. But, Cognitive Behavioral Therapy helps them to assess their thoughts in a structured and conscious way.
As a Cognitive Behavior Therapist, you need to identify the dysfunctional automatic thoughts that your patient is experiencing. The dysfunctional automatic thoughts are the ones that distort reality and get in the way of your patient’s ability to reach their goals.
Furthermore, you need to help your patients identify, evaluate, and respond to their automatic thoughts in a more adaptive way.
(i) Explaining Automatic Thoughts To Patients
The first step in CBT Treatment is to teach your patient to identify the automatic thoughts when his mood is changing. You need to make sure that your patient keeps on practicing this until it’s easy for him to identify such thoughts.
Then, the next step is to teach your patient to evaluate these automatic thoughts. Thus, your patient needs to change his thinking if it is not completely right. However, both you and your patient need to work out a solution if his automatic thoughts are correct.
Finally, you can check to determine if your client has understood the above-mentioned Cognitive Model at the end of the session.
(ii) How To Elicit Automatic Thoughts?
Learning to identify automatic thoughts is the same as learning a new skill.
Therefore as a CBT Therapist, you need to be vigilant to both verbal and non-verbal cues from your patient to bring out his automatic thoughts during the session.
These automatic thoughts may be associated with the patient himself, you as a therapist, or the subject in question. Such thoughts may weaken your patient’s sense of worth and may also interfere with the therapeutic relationship.
However, your patient gets an opportunity to test and respond to the automatic thoughts immediately. Provided he is able to identify his automatic thoughts.
(iii) What are The Techniques To Elicit Automatic Thoughts?
You can use the following techniques in case your patient is unable to explain what was going through his mind.
- Ask them how he felt and where inside the body he experienced the emotion?
- Obtain a detailed description of the problem at hand
- Ask him to visualize the distressing situation
- Suggest him to recreate the specific interaction that he had with you through role play
- Try to obtain a mental image of what he experienced
- Supply opposite thoughts to him
- Uncover the meaning of the situation
- Phrase the question differently
(iv) Identifying Additional Automatic Thoughts
One of the other Cognitive Behavioral Therapy steps is to continue questioning your patients even when they outline an initial automatic thought. Thus, the additional questioning would bring to the front other important thoughts.
Remember, these secondary emotional reactions can be quite distressing. Furthermore, such secondary emotions can make the situation even worse than it is for your patient.
Therefore, as a Cognitive Therapist, it is important for you to determine the points at which your patient was distressed. Furthermore, you also need to figure out what their automatic thoughts were at that point.
(v) Identifying The Problematic Situation
As mentioned above, your patients find it difficult to identify their automatic thoughts related to a particular emotion. In addition to this, your patients may also find it challenging to recognize the issue that is upsetting them.
In such a situation, you need to propose a host of upsetting problems and help them determine the most upsetting problem. Then, you can ask your patient to imagine how he feels where one of those upsetting problems is eliminated.
(vi) Differentiating Between Automatic Thoughts and Interpretations
Many patients indicate interpretations instead of automatic thoughts. This is because they still have not learned to identify their automatic thoughts. As a result, these interpretations say nothing about their automatic thoughts.
Therefore, as a Cognitive Therapist, you need to on your patient’s emotions whenever he reports an interpretation instead of an automatic thought.
(vii) Mentioning Automatic Thoughts Rooted in Discussion
Your patients need to learn to mention the actual words that go through their minds. And how can they learn this?
Well, as a Cognitive Therapist, you need to smoothly lead your patients to recognize the actual words that go through their minds.
This way, you will be able to assess them effectively as a Cognitive Therapist.
(viii) Changing the Form of Question Thoughts
It is common on the part of your patients to report automatic thoughts that are incomplete. Therefore, in such situations, you need to advise them to communicate the complete thought.
Further, you need to guide your patient to express his thoughts in the form of a statement. You should give this guidance before helping them to assess their automatic thoughts.
(ix) Identifying Situations That Can Elicit Automatic Thoughts
Automatic Thoughts can arise both due to external stimuli and internal experiences. This means that your patients can have automatic thoughts in other areas.
Then, an initial emotional, behavioral, or psychological reaction may follow these automatic thoughts. Following this, your patient may have additional thoughts about any part of the Cognitive Model. Hence, this may further lead to additional related emotional, behavioral, and physiological reactions.
It is clear that people suffering from psychological disorders make predictable errors in their thinking. Thus, as a Cognitive Therapist, it is your job to teach your patients to recognize their dysfunctional thinking, to assess the same, and modify it.
Thus, this process begins with recognizing the specific automatic thoughts in particular situations. The ability to identify automatic thoughts varies from patient to patient. This means that it is easier for some patients to identify automatic thoughts. While it may take other patients some amount of practice to identify such thoughts.
Therefore, as a Cognitive Therapist, you need to ensure that your patients outline actual thoughts. So this means you would have to change your questioning in case your patients are unable to recognize their own automatic thoughts.
II. Identifying Emotions
Emotions are the primary element of Cognitive Behavioral Therapy. Furthermore, the symptom relief and abatement of the patient’s disorder are the important goals of Cognitive Therapy.
As we already know, excessive negative emotion is painful and may be dysfunctional. This happens when negative emotions interfere with your patient’s capability to think clearly, solve problems, act effectively, or gain satisfaction.
So, patients suffering from a psychiatric disorder often experience intense emotions. And the intensity of these emotions may be inappropriate to the situation.
However, the intensity of your patient’s emotions matters when you identify the strength of his automatic thoughts and beliefs. This is because such automatic thoughts and beliefs of your patient are highly activated.
Hence, the following are the things you need to do as a Cognitive Therapist to help your distressed patient identify his emotions.
(i) Things CBT Therapists Need To Do In Identifying Emotions
As a therapist, it is important for you to:
- Acknowledge as well as empathize with the way your patient feels
- Not challenge or dispute your patient’s emotions
- Assess the thoughts and beliefs underlying your patient’s distress to reduce his depression
- Restrain yourself from evaluating his emotions
- Not discuss all the situations or events where your patient feels depressed or unhappy
- Determine your patient’s important problematic issues based on your Conceptualization of your patient
- Strive towards increasing your patient’s positive emotions
- Discuss your patient’s interests, positive events occurring in the previous week, and positive memories
- Assign homework to your patient that gives pleasure to your patient
(ii) Differentiate Automatic Thoughts From Emotions
Many patients do not understand the difference between thoughts and emotions. Thus, as a therapist, you need to help your patient understand what he is going through. In addition to this, you also need to share your understanding of the experience with him.
So to achieve this, you:
- Need to organize your patient’s data into the Cognitive Model categories of Situation, Automatic Thought, and Reaction
- Must be vigilant enough in situations when your patient confuses his thoughts and emotions
- Need to either ignore the confusion, address it at that time, or address it later
- Clearly state the difference between emotion and thought to your patient if you choose to address the confusion
- Need to let your patient know that feelings are what you experience and thoughts are the ideas that your patient has
So, the connection among your patient’s thoughts, emotions, and behavior should make sense. This means you need to investigate further when your patient’s emotions do not match with the content of his automatic thoughts.
(iii) Difficulty in Labeling Emotions
You can help your patient learn to label his emotions more effectively using an ‘Emotion Chart’. In the Emotion Chart, your patient can write down the current and previous situations in which he felt a specific emotion. This way he can even refer back to the chart whenever he faces challenges naming how he felt.
In addition to this, as a Cognitive Therapist, you need to make sure that the content of the automatic thoughts must match with the stated emotion.
(iv) Rating Degrees Of Emotion
At times, it is important for your patients to not only identify but also to quantify the degree of emotions they are experiencing.
Thus, you must ensure as a therapist that your patient learns to rate the intensity of his emotions. This is because it will help him in testing his own beliefs.
Besides this, you also need to evaluate whether questioning and adaptively responding to a thought or belief have been effective. This way you can judge whether your patient’s cognition requires further intervention.
However, if you fail to do so, you may end up reaching the wrong conclusions.
(v) Using Emotional Intensity To Direct Therapy
Your patients may not have an understanding regarding the situations that they should bring up for discussion. In such a situation, you can always ask your patients to rate the degree of distress they are still experiencing.
Such a rating would help your patients to decide whether discussion regarding a specific situation would be of any help to them.
III. Evaluating Automatic Thoughts
Your patients have innumerable thoughts a day. Some thoughts are flawed whereas some are functional. However, as a Cognitive Therapist, you need to evaluate only a few ones in a given CBT session.
The following is the manner in which you can evaluate the automatic thoughts of your patients.
(i) Select Key Automatic Thoughts
As a Cognitive Therapist:
- Identify your patient’s automatic thoughts
- Conceptualize whether your patient’s automatic thought is important or not
- Ask questions to your client from the previous week in case the automatic thoughts occurred in the previous week
- Also, ask yourself whether your patient is likely to have this kind of thought again in the future and feel depressed
- Ask additional questions to your patient to determine whether there are certain additional automatic thoughts that are important.
(ii) Use Socratic Questioning To Evaluate Automatic Thoughts
The next step is that you need to collaborate with your patient and evaluate his automatic thoughts. You need not challenge your patient’s thoughts directly. This is because:
- You are unaware of the intensity of your patient’s automatic thoughts beforehand.
- Challenging your patient’s thoughts directly can make him feel invalidated.
- Lastly, directly challenging the thought process of your patient would go against the CBT principle of collaborative empiricism.
Thus, you need to use Socratic Questioning to help your patients evaluate their thinking. It is important to note that the patients need a structured methodology to evaluate their thought processes.
In the absence of a structured method, your patients would respond to their automatic thoughts superficially or unconvincingly. As a result, your patients would not be able to enhance their mood or functioning.
So, what are the questions that you need to ask your patient?
- What is the evidence that supports this idea?
- And what is the evidence that works against this idea?
- Is there any other explanation or viewpoint?
- What is the worst that could happen?
- If it happened, how could I cope?
- What is the best that could happen?
- Then, what is the most realistic outcome?
- What is the effect of my believing the automatic thought?
- So, what could be the effect of changing my thinking?
- What would I tell_____________________ [a specific friend or family member] if he or she were in the same situation?
- What should I do?
(iii) Assess The Outcome of the Evaluation Process
As a Cognitive Therapist, you would evaluate to what extent your patient believes in the automatic thought that came to his mind originally? Additionally, you will determine how your patient feels emotionally once he has evaluated his thoughts.
This will help you as a therapist to determine what you should do next in the CBT Session.
There is a possibility that your patient still believes his original automatic thought to a great extent and feels inferior emotionally. In such a case, you need to conceptualize why your attempt at cognitively restructuring your patient was not sufficiently effective.
You can conceptualize in the following manner:
- Check whether there are other automatic thoughts that you have not evaluated as a therapist
- Ensure that there is no insufficiency in evaluating an automatic thought
- Make sure you do not leave any evidence
- Use a number of techniques to change the fundamental beliefs of your patient
- Discover the unexpressed belief at an emotional level
(v) Use Alternative Methods
As a Cognitive Therapist, you can use alternative strategies in addition to using Socratic Questioning to evaluate the automatic thoughts of your patients.
These strategies include:
- Using alternative questions
- Recognizing Cognitive Distortion
- All-or-nothing thinking
- Emotional Reasoning
- Magnification or Minimization
- Mental Filter
- Mind Reading
- “Should” and “Must” Statements
- Tunnel Vision
- Using Self-Disclosure
(vi) Respond When Automatic Thoughts Are True
At times, the automatic thoughts of your patients turn out to be true. So, you may choose to undertake one or more of the following:
- Emphasize on Solving Problems
- Investigate Invalid Conclusions
- Work Toward Acceptance
(vii) Teach Patients To Evaluate Automatic Thoughts
as a therapist, you need to select one of your patient’s automatic thoughts for which most of the questions are valid. You may do this when your patient is ready to learn the skill of evaluating his automatic thoughts.
Then, you can either give a copy of those questions to your patient following a part of a CBT session. Or else, you can wait until a later time.
So, while handing out the copy of questions to your patient, you can intimate your patient to seek help in case he finds difficulty. This would prevent your patient from self-criticism and defeatism.
(viii) Do Not Use Questions At All
You may simply ask your patients to devise an adaptive response when they have progressed in therapy. That is, they are ready to evaluate their automatic thoughts.
IV. Responding To Automatic Thoughts
Your patient experiences certain automatic thoughts in between the sessions or outside the sessions. There are two types of thoughts that your patient experiences during such a time period.
The first kind of automatic thought is the one that he has already recognized and evaluated during the CBT session. And the second type of automatic thought is Novel Cognition.
So, for the first type of automatic thoughts, you would ensure that your patient has made a note of the robust responses either in writing or in audio format.
Whereas, for the novel cognitions in between the sessions, you need to teach your patient to either use:
- The list of questions mentioned in the above section, or
- Use a Worksheet such as the Thought Record, or
- Utilize “Testing Your Thoughts”
Besides this, there are other ways to respond to automatic thoughts. For instance, your patients can resort to problem-solving, undertake certain relaxation techniques, or accept their thoughts without evaluation.
The following section explains the process that could help your patients to respond to their automatic thoughts. You need to ask your patient to:
- Review therapy notes
- Evaluate and respond to novel cognitions using
- CBT Thought Record
- Testing Your Thoughts Worksheet
- Use other CBT techniques like AWARE
V. Identifying and Modifying Intermediate Beliefs
As a therapist, you need to have deeper understandings that the patients have about themselves, others, and their personal lives. These understandings lead to the development of specific automatic thoughts.
However, these ideas are often unarticulated before CBT Therapy. But, as a therapist, you can easily bring out these ideas.
It is important to note that such beliefs or ideas are often of two types: Intermediate Beliefs and Core Beliefs.
Intermediate Beliefs are the ideas composed of rules, attitudes, and assumptions. Whereas, the Core Beliefs are the rigid and global ideas that your patients have about themselves, others, and the world.
Furthermore, the Intermediate Beliefs are still modifiable relative to the Core Beliefs of a patient.
Now, as a therapist, you first need to develop a Cognitive Conceptualization of your patient before planning CBT Therapy for him. Furthermore, Cognitive Conceptualization would help you to chose suitable CBT interventions.
In addition to this, it also helps you to use other CBT techniques in case the standard CBT interventions fail. Thus, you can use the following process:
- Undertake cognitive conceptualization
- Identify intermediate and core beliefs
- Decide whether to modify a belief or not
- Educate patients about beliefs
- Alter rules and attitudes into the assumption
- Determine advantages and disadvantages of beliefs
- Develop a new belief
- Modify beliefs
VI. Identifying Intermediate and Core Beliefs
Note that your patients may have negative core beliefs about other people and their environment. These are fixed overgeneralized ideas. Hence, these need to be evaluated and modified in addition to the core beliefs that your patient has about himself.
Remember, the positive schema of your patient turns into a negative schema as and when he becomes depressed.
As a result, your patient begins to overemphasize and overgeneralize negative data.
Furthermore, such overgeneralization of the negative data reinforces your patient’s beliefs.
At the same time, your patient fails to identify a significant amount of positive data related to his schema. As a result, the positive data fails to get incorporated into his cognitive schema.
Thus, when this happens, your patient does not voluntarily process information in a dysfunctional manner. This kind of information processing happens automatically and is a symptom of depression.
Therefore, it is important as a therapist to work on modifying the negative core belief of your patient. This will result in not only relieving him from depression. But, it will also reduce the severity of future episodes.
So, you will have to directly start working on modifying the beliefs of your patient as soon as possible in the CBT treatment. This is because it is less likely for your patients to process thoughts in a dysfunctional manner once they change their beliefs.
Steps in Modifying Core Beliefs
- Categorize core beliefs into helplessness realm, unlovability realm, or worthlessness realm
- Use CBT Techniques to identify your patient’s core beliefs
- Collect sufficient data to hypothesize about your patient’s core belief
- Educate your patients about their core beliefs
- Devise a new, more realistic, and functional belief for your patient
- Strengthen your patient’s new core beliefs
- Use Core Belief Worksheet to develop a new core belief for your patient
- Use various other techniques to modify core beliefs
History of Cognitive Behavioral Therapy
The American Psychiatrist Aaron T. Beck developed Cognitive Therapy (CT). Cognitive Therapy is one of the therapeutic approaches within the larger group of Cognitive Behavioral Therapy. And Beck first developed this approach in the 1960s.
Therefore, Aaron T. Beck is the Founder of Cognitive Behavioral Therapy or the Father of CBT Therapy.
In the 1950s, scientists started focusing on subjects like thinking, consciousness, attention, memory, images, and language processing. For instance, Albert Bandura developed the Social Learning Theory.
According to the Social Comparison Theory, children observe a model, internalize its actions, and replicate it when they learn new behavior. These actions involved observation, recognition, and planning.
Therefore, cognitive processes played a central role to learn new behavior according to the Social Learning Approach.
Likewise, the delay of gratification in the Reinforcement process involved a cognitive approach. That is, the gratification that children would get on completing a given task acted as a positive reinforcer for them. Thus, this ability to delay gratification represented the cognitive abilities of children.
Therefore, Behaviorism failed as a result of these ideas and it gave way to the Cognitive Revolution. The Cognitive Revolution began with the field of Cognitive Behavior Modification. And this set the stage for Cognitive Therapy.
Thus, the applications to Mental disorders like anxiety quickly evolved. Apparently, Cognitive Behavioral Therapy and Social Learning Therapy turned out revolutionary movements on their own.
Besides this, CBT developed as a result of another major innovation in the 1970s. This was even more revolutionary than Behavior Therapy.
Development of Cognitive Models
Early Theorists like Albert Ellis and Aaron T. Beck were initially trained in Psychoanalysis. As result, they emphasized concepts like early experience, unconscious process, and personality dynamics.
However, both the theorists recognized that many aspects of Psychodynamic Theory did not contribute significantly towards change in Psychotherapy.
Therefore, both the theorists expressed a practical and simplistic view of human dynamics in behavior change. For instance, both Beck and Ellis emphasized that people’s beliefs had an impact on the manner in which they viewed the world around them. Furthermore, people’s beliefs and interpretation of events contributed more towards their response to those events than the events themselves.
Thus, both theorists used this assumption and developed cognitive models. Albert Ellis developed Rational Emotive Behavioral Therapy (REBT). Whereas, Aaron T. Beck developed Cognitive Behavioral Therapy (CBT).
Both these Cognitive Models emphasized the role of cognitive assessment and cognitive change in behavioral adaptation and emotional success. And soon these cognitive models emerged as well-developed psychotherapies.
Development of CBT Therapy
As per the American Psychological Association, there are two other factors that lead to the development of Cognitive Behavioral Therapy.
Clinical Trials CBT
The Cognitive Behavioral Clinicians and Theorists accepted the use of Clinical Research Methodologies to assess CBT’s outcomes. And this was the first factor responsible for the development of Cognitive Therapy.
Thus, clinicians conducted a huge number of open trials, simple comparative studies, and randomized controlled trials with CBT protocols. These trials and studies began in the 1970s and continued for two decades. Furthermore, theorists or clinicians conducted clinical trials to test CBT as a treatment for various clinical disorders.
Besides this, the CBT Therapy developers also stated certain principles and incorporated them into the treatment. Therefore, the use of these techniques and principles further enhanced the treatment.
It is important to note here that many of the Cognitive Therapy protocols lasted for a short period of time. Thus, the CBT Protocols were reasonably suitable for written treatment manuals.
Diagnostic and Statistical Manual of Mental Disorders (DSM)
The Evolution of the Diagnostic Process itself was the second factor responsible for the development of CBT in the field of cognitive psychotherapy.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a handbook explaining symptoms, descriptions, and other criteria for diagnosing mental disorders. The American Psychiatric Association (APA) publishes this handbook to provide a common language for clinicians to communicate about their patients.
Thus, it helps health care professionals to undertake consistent and reliable diagnoses. And they could use such diagnoses in the research of mental disorders.
Now, DSM forms the basis for much of the clinical research in the field of clinical psychology and psychiatry. And the third edition of DSM published in 1980 was significantly different from the previous versions.
This is because the DSM-III focused on a descriptive account of Psychopathology. Furthermore, the third edition of the DSM removed the theoretical architecture forming a part of the previous versions.
Thus, the shift to descriptive psychopathology allowed clinicians to develop manuals. These manuals targeted the specific symptoms and syndromes as explained in the DSM.
Thus, CBT exploded in the latter half of the 1990s and the early part of the current century due to the above-mentioned factors. In fact, by the 2000s, there were reports that summarized a large number of individual trials and the significant benefits of CBT for mental and physical conditions.
Therefore, we can generally conclude that CBT works for a wide range of disorders and is an evidence-based approach to Cognitive Psychotherapy.
There are cognitive and behavioral techniques that you can use as a Cognitive Behavioral Therapist. You may use these techniques based on your conceptualization of your patient and the goals of the CBT session. The purpose of using these CBT techniques is to influence your patient’s thinking, behavior, mood, and physiological arousal. Thus, the following are the fundamental CBT techniques used to modify the thinking and behavior of your patient.
Major Cognitive Behavioral Techniques
1. Problem-Solving Skills and Training
You need to encourage your patients to come up with the agenda problems that they encountered during the week. Then, you also need to persuade them to come up with the problems that might be distressful in the coming weeks.
Further, you will guide your patients to come up with solutions to those problems. You may ask them how they solved similar problems in the past.
Also, you may question them regarding the advice they would have given to their friend or family member facing a similar problem. Then, you can provide your patients with the potential solutions to the problem, if need be. Now, some patients may not have good problem-solving skills.
In such a case, you would have to give them direct instructions. For instance, you would have to teach your patients to specify a problem, come up with solutions, select a solution, implement it, and then evaluate its effectiveness. However, some patients have good problem-solving skills. They may just require your help in implementing those skills.
2. Making Decisions
Depressed patients find it challenging to make decisions. Thus, they want to seek your help in this area. As a CBT Therapist, you would ask your patients to list down the advantages and the disadvantages of each of the options they have in mind while making decisions.
Then, you will help them come up with a system that helps them to weigh each option and work out a conclusion about the option that seems the best.
Your patients need to determine their automatic thoughts on the spot and evaluate them. Or else, they need to read their therapy notes that would prevent their thought process from detouring.
However, in certain situations, this CBT technique may not be feasible or desirable. Therefore, you need to make effort to refocus the attention of your patients.
The CBT technique of refocusing is useful when concentration is needed for the task at hand. Besides this, this CBT strategy is also useful when your patients are having obsessive thoughts regarding something.
Because during such times, rational evaluation of thoughts is ineffective for your patients. In addition to this, this technique is also useful when your patients have obsessive thoughts. This is because, in such a situation, your patient is not able to effectively evaluate things rationally.
Thus, as a CBT therapist, you need to teach your patients to label and accept their experiences. Then, your patients should intentionally focus their attention on what they are writing.
Further, they also need to deliberately focus on what others are saying and their road ahead. Therefore, you need to rehearse this strategy with your patients. You need to bring to their consciousness the manner in which they refocused their attention in the past. Or, how they believe they could do it in the future.
4. Use Activity Chart
It is quite useful to use Activity Chart in the case of some patients. This chart is used not to schedule activities. But, it is used to track your patient’s moods while they perform various activities. This chart would help you to look for patterns of occurrence.
Say, for instance, your patient has an anxiety disorder. He may use this chart to write down the activities he performed.
Further, he will rate his level of anxiety as low, moderate, or high while performing such activities. Such a scale would help the patient to understand the mild or severe shifts in behavior or emotion he experienced while performing the activities.
5. Relaxation and Mindfulness
The relaxation and mindfulness techniques turn out to be beneficial for many patients. There are different kinds of relaxation exercises. These include progressive muscle relaxation, imagery, and controlled breathing.
As a CBT Therapist, you need to teach these relaxation techniques to your patients during the CBT session itself. This would help you to deal with your patients’ problems and assess the efficacy of such techniques.
However, these techniques backfire in the case of certain patients. Instead of feeling relaxed, they feel tensed and anxious. Therefore, you first need to ask your patients to try out any of the relaxation techniques.
Then, you can evaluate whether such a technique is reducing anxiety or leading to more anxious thoughts. You can even try Mindfulness techniques with your patients.
Mindfulness techniques help your patients to observe and accept their internal experiences without any judgments.
6. Graded Task Assignments
You can make use of a graphic depicting steps or milestones your patients need to take one by one to reach their goals.This will not overwhelm them as they will only focus on the current step and not on how far they are from their goal.
One of the coping strategies that patients suffering from anxiety often engage in is avoidance. These patients may avoid performing certain activities as they feel hopeless or fearful.
The pattern of avoidance may be quite subtle or quite apparent. This coping strategy may bring temporary relief to your patient.
But it perpetuates the problem. This is because, in such situations, your patients do not get the opportunity to test their automatic thoughts.
Hence, they are not able to collect the disconfirming data. Thus, you need to provide a strong rationale to such patients in exposing themselves to fearful situations.
You can help them identify an activity associated with low to moderate discomfort. Then, ask them to perform this activity every day until their anxiety has decreased significantly.
Following this, you can identify a new situation that is relatively more challenging for them to face. Then, encourage them to expose themselves frequently to such a situation until they engage in it with relative ease.
You can use role-playing for a wide range of purposes. These include uncovering automatic thoughts, developing an adaptive response, modifying intermediate and core beliefs, etc.
In addition to this, you can use role-playing to help your patients learn and practice social skills. However, before teaching social skills, you must ascertain the level of social skills your patients already have.
Many patients precisely know what to do. However, they have difficulty making use of this knowledge. This is because of their dysfunctional assumptions. So, one way to assess your patients’ social skills is to make your patients assume a positive outcome of a given situation.
9. Use The Pie Technique
You can make use of a pie chart to help your patients set goals or determine the relative responsibility for a given outcome. This is because putting ideas in a graphic form is quite helpful for your patients.
10. Self-Comparisons and Credit Lists
Individuals suffering from psychiatric disorders typically process information in a negative way. This happens especially when they evaluate themselves.
In other words, they just take note of negative information and ignore or neglect the positive data. Besides this, such people make dysfunctional comparisons.
In other words, they either compare themselves at present with how they were before the disorder. Or they compare themselves with what they like to be or with others who do not have a psychiatric disorder. Thus, such negative thoughts increase their distress.
So as a therapist, you need to help your patient see that his or her comparisons are dysfunctional. Furthermore, you can also ask your patient to maintain a credit list. A credit list is nothing but a daily list of positive things that your patient does.
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